Clinical Value and Utility of the 18F-FDG PET/CT in Detecting Prosthetic Infection After the Aortic Valve and Thoracic Aorta Reconstruction

Aim/Introduction To assess the utility of 18F-FDG PET/CT in detecting infection in aortic vascular prostheses. Identify the morphometabolic characteristics that allow discerning between post-surgical inflammatory changes and the infectious process. Correlate PET/CT findings with clinical data. Materials and Methods A retrospective descriptive study in patients undergoing reconstruction of the aortic valve and thoracic aortic artery with prosthetic devices who presented clinical suspicion of prosthetic infection and underwent an examination with 18F-FDG PET/CT for diagnostic purposes. Twelve patients were reviewed from March 2016 to October 2023. Demographic data, vascular devices, symptoms, clinical analysis, and the characteristics of the PET/CT study were studied, contrasting with the final diagnosis. Results 12 patients (8 men) with a mean of 71 years old (53-82) were analyzed. The 2 patients that PET/CT classified as positive were true positives; 3 were classified as doubtful: 1 was positive, and the other 2 were negative. Two of those positive for endocarditis presented heterogeneous uptake; the other showed a focal uptake on the PET image. The positive patients showed a higher semiquantitative uptake index (SUVmax) in the suspicious images and a slight elevation of leukocytes compared to the negative patients. The CT identified abscesses in 2 of the 3 positive patients. The 7 patients that PET/CT classified as negative were true negatives. Conclusion 18F-FDG PET/CT allowed us to reject all negative patients, avoiding unnecessary surgeries and prolonged courses of antibiotic therapy. It demonstrated excellent performance in the detection and localization of infectious processes. The focal uptake pattern and the abscess were the PET/CT image findings that were most associated with the diagnosis of infection.